Provider Demographics
NPI:1386329217
Name:GENIESSE, MOLLY KRISTINE (BSN-RN)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:KRISTINE
Last Name:GENIESSE
Suffix:
Gender:F
Credentials:BSN-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4627
Mailing Address - Country:US
Mailing Address - Phone:920-323-7964
Mailing Address - Fax:
Practice Address - Street 1:1261 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4627
Practice Address - Country:US
Practice Address - Phone:920-323-7964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2399464163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy